title: Postoperative fentanyl patch versus subacromial bupivacaine infusion in arthroscopic shoulder surgery.
abstract: OBJECTIVE
  The purpose of our study was to compare the effectiveness of subacromial bupivacaine infusion and a transdermal fentanyl patch in the treatment of postoperative pain after arthroscopic shoulder surgery.
  
  
  METHODS
  Sixty patients with rotator cuff disease scheduled for elective arthroscopic shoulder surgery were enrolled in the study. For the treatment of postoperative pain, 30 patients constituted group F and received a 12.0-μg/h fentanyl patch for 72 hours and saline solution infusion in a subacromial manner at the rate of 4 mL/h. The remaining 30 patients constituted group B and received a placebo patch and an infusion of 2.5-mg/mL bupivacaine in a subacromial manner for 72 hours. The primary outcome measure was the postoperative numerical rating scale pain score. The consumption of opioids, ibuprofen, and acetaminophen was also recorded. The Constant scores and general recovery were followed up until the 90th postoperative day.
  
  
  RESULTS
  There was no statistically significant difference in the numerical rating scale scores (P = .60) between the groups. No differences in the use of rescue analgesic were observed except that the patients receiving bupivacaine used more ibuprofen (median, 1,200 mg v 600 mg) during the day of surgery (P = .042). No difference was found in general recovery between the groups.
  
  
  CONCLUSIONS
  A fentanyl patch delivering 12-μg/h fentanyl offers an easy and safe treatment option as a part of multimodal analgesia with few adverse effects in the treatment of postoperative pain in a carefully selected patient group after arthroscopic shoulder surgery.
  
  
  METHODS
  Level I, randomized controlled trial.
authors.affiliation: Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital and University, Turku, Finland. riika.merivirta@tyks.fi
authors.forename: Riika
authors.initials: R
authors.lastname: Merivirta
authors.forename: Ville
authors.initials: V
authors.lastname: Äärimaa
authors.forename: Riku
authors.initials: R
authors.lastname: Aantaa
authors.forename: Mari
authors.initials: M
authors.lastname: Koivisto
authors.forename: Kari
authors.initials: K
authors.lastname: Leino
authors.forename: Antti
authors.initials: A
authors.lastname: Liukas
authors.forename: Kristiina
authors.initials: K
authors.lastname: Kuusniemi
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001182:Arthroscopy / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017006:Rotator Cuff / Q000601:surgery*; D012782:Shoulder / Q000601:surgery; D057968:Transdermal Patch
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000082:Acetaminophen; D010098:Oxycodone; D005283:Fentanyl; D007052:Ibuprofen; D002045:Bupivacaine